Taking Care When Managing Continence
To stay continent a person needs to be able to safely empty their bladder or bowel when they need to. Getting to the toilet on time may be difficult if the person has problems with strength, stamina or mobility. Using the toilet may be difficult if a person is unable to sit safely on the toilet. Problems with memory, orientation and understanding may also cause difficulty with getting to the toilet on time or using the toilet safely. A healthy diet and plenty to drink is also important to keep bladder and bowel functioning well.
If the person’s diet or medical condition is affecting continence, contact their GP or a nurse from the bladder and bowel service for advice.
The most efficient position for going to the toilet is a squatting position, as this puts the bladder and bowel in the best position to empty without restrictions. But squatting is not possible on a conventional toilet.
To be in the best position to empty bladder and bowel on the toilet, the person’s feet should be firmly on the floor, their knees should be no higher than their bottom and the angle at their ankles, knees and hips should be no more than 90° as in this diagram. This creates the best position to fully empty their bladder and bowel. If the seat is too high the bladder or bowel cannot be emptied properly, this can lead to urine infections or constipation.
Getting on and off the toilet can be difficult if you have problems with strength or mobility. A high toilet seat might help, but these seats are usually too high for going to the toilet effectively, as in this diagram. The person’s feet don’t reach the floor and emptying of the bladder and bowel will be restricted. Also the hole in these seats is small; too small for men who sit to go to the toilet. Instead, try toilet surround rails or rails that are fixed to the wall to give a firm support to help getting up from the toilet.
Urinals can be used when it is difficult to get to the toilet or to get on and off the toilet. Bottles are available for men and some urinals are suitable for women too. Some have a collection bag so that emptying the urinal is easier, like this one from Beambridge Medical.
Clothes can help when getting to the toilet on time. Simple fasteners, elasticated waists and loose fitting underwear can help to get to the toilet on time.
Cleaning after using the toilet is easier if the toilet seat has a large hole. If grip or reach is difficult, there are gadgets with a long handle or a spray wash that can make it easier too.
Taking Care when memory, understanding or disorientation affects continence
The person may not recognise the feeling that the bladder or bowel is full and so is unable to get there in time. Poor mobility may also prevent timely access to the toilet, check that walking equipment is manageable and that it fits through the toilet door easily.
Difficulty with communication may stop the person asking for help to go to the toilet or they may not be able to find the toilet or recognise the toilet.
The person may forget how to perform the actions needed to use the toilet or they may not recognise that they are on the toilet so may not use it or may be too distracted by the environment to use the toilet.
Tips to keep continent with memory, orientation or understanding problems
Establish a routine with reminders or a ‘timetable’ for regular toilet use. Ensure the person drinks enough fluids to encourage bladder and bowel function.
Keep the route to the toilet clear and well lit and make sure the toilet door is visible, recognisable and easy to open and close. Make sure the toilet is recognisable and clear to see against the wall and floor, traditional dark toilet seats may stand out better in a bathroom, using red toilet seats may sometimes be counterproductive as red may be associated with heat or danger and may not be associated with a toilet. Avoid using extra equipment unless it is essential for getting on and off the toilet.
Give the person privacy and time to use the toilet in a calm environment. When on the toilet the person may need reminding to empty bladder and bowel, use familiar words and give simple, clear instructions. Some people could be encouraged to lean forwards or to touch their toes or to press their tummy gently, when seated on the toilet, to help the bladder and bowel to empty.
Familiar clothing, with elasticated waist or simple fastenings may be easier to get on and off when going to the toilet, and if the person wears pads, stick on or pull up pads are easier than loose pads when managing pants when going to the toilet.
If the person needs to go to the toilet at night, ensure bed equipment and lighting helps them to get up, find the toilet, urinal or commode and get back in to bed. Technology may be useful to alert an on site carer that the person has got out of bed to go to the toilet as this may prevent falls and give the carer peace of mind when the person is safely back in bed.
If the person has a medical condition that is affecting continence contact their GP or a nurse from the bladder and bowel service for advice.